U.S. patent application number 12/445366 was filed with the patent office on 2010-01-14 for clinician decision support system.
This patent application is currently assigned to Koninklijke Philips Electronics N.V.. Invention is credited to Erica Cummings, Sebastian Hebler, Oliver Roth, Gerhard Tivig.
Application Number | 20100010319 12/445366 |
Document ID | / |
Family ID | 39283261 |
Filed Date | 2010-01-14 |
United States Patent
Application |
20100010319 |
Kind Code |
A1 |
Tivig; Gerhard ; et
al. |
January 14, 2010 |
CLINICIAN DECISION SUPPORT SYSTEM
Abstract
A bedside patient monitor comprises a clinician support system.
The clinician support system comprises at least one of the
following modules of: a disease-specified decision module (11),
disease-specified treatment module (13) or disease-specified
observation module (15). The bedside monitor comprises a first
interface (105) for manual patient-related input and a second
interface (107) for continuous input of a sensor signal. The
clinician is supported to deliver requested information and execute
the treatment in a predetermined way supported by the clinician
support system.
Inventors: |
Tivig; Gerhard; (Boeblingen,
DE) ; Hebler; Sebastian; (Herrenberg, DE) ;
Roth; Oliver; (Herrenberg, DE) ; Cummings; Erica;
(Wendlingen, DE) |
Correspondence
Address: |
PHILIPS INTELLECTUAL PROPERTY & STANDARDS
P. O. Box 3001
BRIARCLIFF MANOR
NY
10510
US
|
Assignee: |
Koninklijke Philips Electronics
N.V.
Eindhoven
NL
|
Family ID: |
39283261 |
Appl. No.: |
12/445366 |
Filed: |
October 8, 2007 |
PCT Filed: |
October 8, 2007 |
PCT NO: |
PCT/IB2007/054082 |
371 Date: |
April 13, 2009 |
Current U.S.
Class: |
600/300 |
Current CPC
Class: |
G16H 40/63 20180101;
G16H 20/00 20180101; G16H 20/40 20180101; G16H 10/20 20180101 |
Class at
Publication: |
600/300 |
International
Class: |
A61B 5/00 20060101
A61B005/00 |
Foreign Application Data
Date |
Code |
Application Number |
Oct 12, 2006 |
EP |
06122149.5 |
Claims
1. A bedside patient monitor comprising a clinician support system,
a first interface for manual patient-related input and a second
interface for continuous input of sensor signals, wherein the
clinician support system comprises at least one of the following
modules: a disease specified decision module, disease-specified
treatment module or disease-specified observation module.
2. A bedside patient monitor as claimed in claim 1, wherein the
clinician support system comprises at least one disease-specified
treatment module to support the clinician in the treatment process,
wherein the disease-specified treatment module being started only
by a qualified manual input trigger signal.
3. A bedside patient monitor as claimed in claim 2, wherein the
clinician support system comprises at least one observation support
module for observation of the treated patient, the
disease-specified observation module being activated by a signal
generated through deactivation of the disease-specified treatment
module.
4. A bedside patient monitor as claimed in claim 2, comprising an
indicator for signaling the running treatment procedure.
5. A bedside patient monitor as claimed in claim 1, wherein the
clinician support system comprises an information delivery tool to
deliver requested information requested by at least one of the
disease-specified modules, wherein the information delivery tool
generates a pop-up window to trigger manual input through the first
interface if the requested information is not available through the
interface for automatic input or connected remote sources.
6. A bedside patient monitor as claimed in claim 5, wherein the
remote resource is a remote central station or remote microanalysis
center.
7. A method of clinician support with disease-specified modules to
support decision process, treatment process for observation
process, wherein automatic input is recognized and manual input is
triggered to deliver non-available information, wherein the
information being requested by the running supported process to
deliver the information through the first interface.
8. A method of clinician support as claimed in claim 7, wherein
different disease-specified modules of different diseases could be
active in parallel, and only one module of a specified disease is
running at the same time.
9. A method of clinician support as claimed in claim 8, wherein the
manual input of information request triggered by a running
disease-specified treatment module is executed before a manual
input request triggered by a running decision module is
executed.
10. A method of clinician support as claimed in claim 8, wherein a
manual input of information request triggered by a running
disease-specified decision module is executed before a manual input
request triggered by a running disease-specified observation module
is executed.
11. A method of clinician support as claimed in claim 7, wherein an
unanswered manual information request will reappear after a
predetermined time slice, preferably 5 or 10 minutes.
12. A method as claimed in claim 7, wherein a status overview of a
running module is displayed automatically at least once an hour.
Description
[0001] This invention is directed to a clinician decision support
system.
[0002] US 2006/0122869 A9 discloses a system and method for
standardizing care in a hospital environment from a remote
location. The information concerning the latest care and practice
standards for a given condition is provided to a decision support
module. The decision support module comprises decision support
algorithms that reflect a standardized guideline of practice for a
particular medical condition. By means of this system it is
possible to provide a 24-hours/7-days-a-week patient monitoring and
management service to multiple, geographically dispersed Intensive
Care Units. To allow remote visual monitoring of the patients, the
system comprises video monitors. The system comprises an interface
to allow a physician to get access to a physician resource
database. The database comprises diagnosis algorithms. So the
physician gets standardized information about a standardized
diagnosis algorithm. Further standardized care and treatment is
provided by the physician resource database.
[0003] Many medical organizations are active in developing
guidelines for recognition of a disease and treatment of the
disease, for example "surviving sepsis campaign".
[0004] It is an object of the invention to provide a support
device/system to support the medical staff in the use of
standardized guidelines and standardized treatment guidelines.
[0005] This object is achieved by means of a clinician support
system. The clinician support system comprises at least one of the
following modules: a disease-specified decision module,
disease-specified treatment module or disease-specified observation
module and a first interface for manual patient-related input and a
second interface for continuous input of sensor signals. So it is
possible to deliver manually measured physiological values by means
of the first interface. Further, continuously measured signals are
delivered by the second interface. Continuously measured signals
are signals measured within predetermined time intervals, and the
measured signals will be delivered automatically, without user
interaction.
[0006] In one embodiment of the bedside patient monitor of the
invention, the clinician support system comprises at least one
disease-specified treatment module to support the clinician in the
treatment process, the disease-specified treatment module being
started only by a qualified manual input trigger signal.
[0007] In one embodiment of the bedside patient monitor, the
clinician support system comprises at least one observation support
module for observation of the treated patient and the
disease-specified observation module is activated by a signal
generated through deactivation of the disease-specified treatment
module.
[0008] In a further embodiment of the bedside patient monitor, an
indicator is provided for signaling a running treatment procedure.
So it could be recognized instantly that a treatment procedure is
running. This helps the clinician's staff in planning further
action for the patient. Further, if a clinician support screen is
displayed on the display of the bedside patient monitor the
clinician is supported in getting a good overview of the status of
the patient. For example the indicator of the running
disease-specified module. The icon can be used for indication of
the actual running module, if a decision, treatment or observation
module is running. Different icons can be used for different
diseases.
[0009] In one embodiment of the bedside patient monitor, the
clinician support system comprises an information delivery tool.
The information delivery tool spreads around a request for
information in the case that the requested information is not
delivered by the second interface. For example a request is sent to
the central station of the hospital, using a network connection,
especially wireless connection, to the hospital network or a
request is delivered to a remote microbiological institute or
center by means of the internet. The request comprises a patient
identification to make sure that the information assigned to the
correct patient will be delivered. For example, an identification
code is provided by a bedside device, for example the bedside
patient monitor.
[0010] Especially body fluids or probes are analyzed in remote
microbiological centers. So this requested information, if
available, is delivered to the clinician support system. Of course
the request could comprise patient identification information to
make sure that the requested information of the correct patient
will be delivered. If the requested information is not available,
the information delivery tool generates a pop-up window on the
display of the bedside patient monitor to trigger manual input
through the first interface. The pop-up window will disappear if
the requested information is delivered.
[0011] The bedside patient monitor is used to carry out the
clinician support method. During the clinician support method at
least one of disease-specified modules to support the decision
process, treatment process or observation process are activated.
The method comprises the recognition of automatic input and the
triggering of manual input to provide the information requested by
a running module.
[0012] In one embodiment, the method generates pop-up windows, to
trigger the manual input. The pop-up windows are displayed on the
display of the patient monitor. In dependence on the requested
input, the manual input of different persons will be accepted. For
example a manual input of a temperature measurement value carried
out by the patient himself could be accepted.
[0013] In one embodiment the method stores the manual input
information linked with an identification code. The identification
code is assigned to a person or a group of persons. By means of
this identification code it is possible to establish which person
made the manual input.
[0014] In one embodiment a method is provided, wherein the request
for manual input requested by a running treatment process is
carried out preferred to a request of a running decision or running
observation module.
[0015] In a further embodiment a request generated by a running
decision module is carried out preferred to a generated request of
a running observation module.
[0016] In one embodiment an unanswered request will appear after a
predetermined time. Especially 5, 10 or 15 minutes after closure of
the request window, the request will reappear. Especially in
dependence on the requested information, different durations for
reappearance of the window can be predetermined.
[0017] In the following, the clinician support system and method of
clinician support is described in more detail. A very detailed
description is given in respect of the disease of sepsis, but the
scope of this invention is not limited to the described specific
embodiments.
[0018] The clinician support system supports the clinical staff in
recognition, treatment and observation of several diseases. There
are many activities in the medical society to generate standardized
guidelines for treatment of several diseases, for example
sepsis.
[0019] The invention is described in more detail hereinafter,
especially for the example of sepsis.
[0020] FIG. 1: Clinician support system
[0021] FIG. 2: Bedside patient monitor comprising the clinician
support system
[0022] FIG. 3: Flowchart of sepsis decision, treatment and
observation process
[0023] FIG. 4: Infection Signs und Symptoms window
[0024] FIG. 5: New Infection window
[0025] FIG. 6: Lactate request window
[0026] FIG. 7: Hypotension Evaluation request window
[0027] FIG. 8: Infection confirmation window
[0028] FIG. 9: Clinician authorized window
[0029] FIG. 10: Sepsis treatment screen
[0030] FIG. 11: Sepsis treatment recommendation monitoring
window
[0031] FIG. 12: Sepsis treatment deactivation window
[0032] FIG. 13: Sepsis observation window
[0033] FIG. 14: Protocol Log
[0034] Furthermore, the terms first, second, third and the like in
the description and in the claims are used for distinguishing
between similar elements and not necessarily for describing a
sequential or chronological order. It is to be understood that the
terms so used are interchangeable under appropriate circumstances
and that the embodiments of the invention described herein are
capable of operation in other sequences than described or
illustrated herein.
[0035] Moreover, the terms top, bottom, over, under and the like in
the description and the claims are used for descriptive purposes
and not necessarily for describing relative positions. It is to be
understood that the terms so used are interchangeable under
appropriate circumstances and that the embodiments of the invention
described herein are capable of operation in other orientations
than described or illustrated herein.
[0036] It is to be noticed that the term "comprising", used in the
present description and claims, should not be interpreted as being
restricted to the means listed thereafter; it does not exclude
other elements or steps. Thus, the scope of the expression "a
device comprising means A and B" should not be limited to devices
consisting only of components A and B. It means that with respect
to the present invention, the only relevant components of the
device are A and B.
[0037] In FIG. 1 the general structure of the clinician support
system 1 is shown. The clinician support system comprises a
decision support module 3 comprising disease-specified decision
modules 11. Here a disease-specified module is a sepsis decision
module 17. The sepsis decision module is linked with a sepsis
treatment module 19. The sepsis treatment module is one example of
a disease-specified treatment module 13. The disease-specified
treatment modules 13 are part of a treatment support module 5.
Disease-specified observation modules 21 are part of an observation
support module 7. A disease-specified observation module 15 could
be assigned to a disease-specified treatment module 13. As shown in
FIG. 1, an treatment, decision and observation modules are not
provided for all diseases. The modules 11, 13, 15 assigned to the
same disease are linked. So the sepsis decision module is linked
with the sepsis treatment module. The sepsis treatment module is
linked with the sepsis observation module. In the same way, the
weaning treatment module 23 is linked with the weaning observation
module 25. It is also possible to use the clinician support system
only for the decision process 4 or the treatment process 6 or the
observation process 8.
[0038] The decision support module 3, treatment support module 5,
observation support module 7 are linked to an information delivery
tool 27. A further storage 31 to store patient related information
and to store guidelines supported by the clinician support module
such as the Sepsis Resuscitation Bundle, is provided.
[0039] In the following the invention is described for the disease
of sepsis/septic shock in more detail. Of course the use of the
clinician support system is not limited to this example.
[0040] The clinician support system 1 comprises decision support
module 3, treatment support module 5 and observation support module
7.
[0041] The decision support module 3 comprises the sepsis decision
module 17. The sepsis decision module 17 provides support in
respect of measurement values and evaluation of the patient status
compared to the standardized sepsis guidelines criteria.
[0042] The surviving sepsis campaign (SSC) developed a guideline
for detection, treatment and observation of septic patients. The
clinician support system 1 supports the clinician in using for
example the surviving sepsis campaign (SSC) guidelines. The
clinician support system 1 assists in recognizing the early signs
and symptoms of the specified diseases, for example sepsis, by
comparing the detected state of the patient to the guidelines
criteria. After recognition of this specific disease, the clinician
is guided through the recommended treatment steps as defined in the
guideline by the treatment support module 5 comprising
disease-specified treatment module 13, here sepsis treatment module
19.
[0043] When the sepsis decision module 17 has recognized that the
specified criteria have been met, the sepsis decision module 17
triggers to display of a predetermined window. This window requests
a confirmation of the presence of infection and sepsis-related
organ dysfunction by a qualified person. It is possible to display
the window for this request only on a bedside patient monitor 101
assigned to that patient to make sure that the qualified person
gets an impression of the acuteness.
[0044] The sepsis treatment module 19 is activated by a qualified
trigger signal generated through the manual input 105 of the
bedside patient monitor. Only a professional clinician is qualified
to generate the qualified manual input trigger signal. The
recognition of a manual input trigger signal generated by a
qualified person could be approved by a requested identification
code, fingerprint and so on.
[0045] The treatment support module 5 supports the treatment of the
patient in general, said treatment support module comprises
disease-specified treatment modules 13 to provide support in the
treatment of a special disease. So to carry out the sepsis
treatment guideline named Sepsis Resuscitation Bundle is supported
by the sepsis treatment module 19.
[0046] The sepsis treatment module triggers the display of the
surviving sepsis campaign (SSC) recommendations listings for
resuscitation on the display of the bedside patient monitor.
[0047] The recommendations can be checked off as they are
implemented. After the sepsis treatment module 19 recognizes the
achievement of all the resuscitation goals, or after 6 hours at the
latest, the sepsis treatment module 19 is completed and the sepsis
observation module 21 is activated by a trigger signal generated by
the treatment support module 19.
[0048] The sepsis observation module 21 supports the clinician to
carry out the Sepsis Management Bundle--the SSC recommendations to
maintain patient status are listed and can be checked off as they
are implemented. The Sepsis Management Bundle ends when 24 hours
have passed since the Sepsis Resuscitation Bundle began, or if all
recommendations of the Management Bundle were checked off, FIG. 2.
If a patient has already been diagnosed as septic before connecting
him to the monitor, the septic treatment module can be
activated/entered by a qualified manually generated trigger
signal.
[0049] In FIG. 3 a bedside patient monitor 101 comprising a
clinician support module 1 is shown. The bedside patient monitor
101 comprises a first interface 105 connected to a keyboard 111 and
a second interface 107 connected to at least one patient-connected
device or sensor. The patient-connected device is used for
providing physiological information automatically, for example
continuous temperature measurements. The bedside patient monitor
comprises a display 103. The bedside patient monitor comprises the
option to establish a connection to a clinical network 115 and/or
the Internet. The network connection can be a wireless connection.
The Internet connection can be used to update stored clinician
recommendations and guidelines on a regular basis automatically.
Further, the Internet or clinician network connection can be used
to provide patient-related information generated for example at a
microbiological laboratory, which could be separate from the
hospital.
[0050] If a disease-specific predetermined set of information is
recognized by the clinician support system 1, the disease-specific
decision support module 11 is started. In the case of sepsis the
sepsis decision module 17 is started as soon as an adult patient is
connected to the bedside patient monitor, and heart rate or pulse
is being measured. The sepsis decision module 17 triggers to
observe heart rate, temperature and respiration rate values in the
background. If temperature information or respiration rate
information is not measured continuously by way of a sensor 108
connected to a second interface 107 for continuous measurement, a
pop-up window will appear at predetermined intervals, for example
4-hour intervals, to trigger the manual measurement and input of
the requested information. The information will be delivered to the
sepsis decision module by use of the first interface 105 for manual
input. The pop-up window can be closed without entering the
requested information, but after a predetermined interval,
preferably shorter than the normal interval, pop up of this window
is triggered again by the sepsis decision module 17.
[0051] The manually entered values are labeled with the information
about the person and time of input. These available values are all
compared to the sepsis guideline criteria: HR above 90, Temp above
38.3.degree. C. (100.9.degree. F.) or below 36.0.degree. C.
(96.8.degree. F.), respiration rate (RR) above 20.
[0052] If any one of the values fulfils the screening criteria, the
sepsis decision module 17 triggers display of an Infection Signs
and Symptoms window shown in FIG. 4.
[0053] The measured value, which has fulfilled the criteria, is
shown blinking (in the example shown above it is tachycardia).
[0054] There will be a check box for the infection signs and
symptoms listed, [0055] if the clinician support system received
requested information through the second interface 107, wherein the
delivered information meets the guideline criteria, and [0056] for
all signs and symptoms which are not available through the second
interface 107 or the information delivery tool 27.
[0057] The information delivery tool 27 is part of the clinician
support system 1 as described before. The information delivery tool
27 sends requests to remote locations to provide the needed
information, for example to collect the requested information from
a connected central station or a connected remote medical
laboratory center. If the requested information is not delivered by
the information delivery tool 27, a window is triggered by the
sepsis decision module 17 to trigger a manual input.
[0058] The clinician is requested to check a box whether the sign
or symptom in question is both present and new, if so a
confirmation is requested by the sepsis decision module 17. If the
patient is mechanically ventilated, the Tachypnea box must be
checked. If temperature or respiration rate is measured manually,
the measured values can be delivered by using an "Enter RR" key
(not shown) for respiration rate input and "Enter Temp" key (not
shown) for manual temperature input. By selection of "Confirm" key
125 confirmation information is stored by the clinician support
system 1, here by the sepsis decision module 17.
[0059] If a request window is closed without input, the request
window will be triggered again after a predetermined period of
time, especially after less than 15 min or 10 min or 5 min.
[0060] Further, the window will reappear, triggered by the sepsis
decision module 17 if the HR, Temp or RR value, which previously
fulfilled the criteria, now becomes worse, or after 8 hours,
configurable to 12 hours, if at least one infection sign is still
present.
[0061] If the sepsis decision module 17 recognized confirmation of
two or more infection signs in the Infection Signs and Symptoms
window of FIG. 4, a new pop-up window is triggered by the sepsis
decision module 17 shown in FIG. 5, which window will appear on the
display of the bedside patient monitor 101. In the following, all
described windows are displayed on the display of the bedside
patient monitor 101.
[0062] If the sepsis decision module 17 receives a signal
representing that "Yes" is selected, the next screen is triggered
by the sepsis decision module 17 requesting an input of a lactate
measurement value.
[0063] If a signal representing the selection of "No" is received
by the sepsis decision module 17, the decision phase will continue
and the Infection Signs and Symptoms window, see FIG. 4, reappears
if the measurement value which previously fulfilled the criteria
becomes worse, or after 8 hours (configurable to 12 hours) at the
latest if at least one infection sign is still present, which
reappearance is triggered by the sepsis decision module.
[0064] Manual lactate input, see FIG. 6:
[0065] The user is invited to manually enter the Lactate value, see
FIG. 6, by selecting an "Enter Lact" key 121 if the lactate value
is not provided to the sepsis decision module by the information
delivery tool 27. If the information is delivered by the
information delivery tool 27, the window of FIG. 5 does not appear.
If the value entered is >4 mmol/l, the check box will be
automatically checked.
[0066] By selecting "Confirm" 125 the entered value is sent to the
sepsis decision module and the confirmation information is stored
by the clinician support system. All information delivered during
the use of the clinician support system 1 is stored in a storage,
which is part of the bedside patient monitor. Additionally, storage
of the provided information at a central storage of a connected
central station can be made possible.
[0067] If a signal representing a Lactate value >4 mmol/l
arrives at the sepsis decision module, the sepsis decision module
17 recognizes that the value meets the SSC guidelines criteria for
sepsis. The sepsis decision module 17 triggers the display of a
window to request approval by authorized clinician review. By a
signal representing the authorized clinician review, the sepsis
decision module is deactivated and the sepsis treatment module is
activated. The signal representing authorized approval is generated
by the manual input 105.
[0068] If a signal representing a Lactate value .ltoreq.4 mmol/l is
delivered to sepsis decision module 17, a further window will
appear, triggered by the sepsis decision module 17, in the case
that the blood pressure value is not made available by the second
interface 107 for continuous measurement. This window requests
manual input of blood pressure values to determine on the basis of
blood pressure values whether the patient meets the sepsis
guideline criteria for sepsis.
[0069] Hypotension Evaluation
[0070] If the Lactate value was not above 4 mmol/l, the sepsis
decision module 17 triggers the next window, see FIG. 7, to request
the input in respect of persistent hypotension.
[0071] Hypotension is defined by the SSC guidelines as: [0072] SBP
<90 mmHg (12.0 kPa), or [0073] MAP <65 mmHg (9.0 kPa), or
[0074] SBP decrease >40 mmHg (5.0 kPa) below baseline.
[0075] By selecting "Show Details" key 127, the definition of
hypotension defined in the sepsis guidelines will be displayed. By
selecting YES, persistent hypotension as defined in the sepsis
guidelines is recognized by the sepsis decision module 17. Then a
final window is triggered requesting authorized approval, by which
authorized approval a signal is generated to deactivate the sepsis
decision module 17 and to activate the sepsis treatment module 19,
FIG. 9.
[0076] If a signal is generated representing the input that the
patient does not have persistent hypotension, the sepsis decision
module 17 triggers the appearance of the window shown in FIG. 8
after one hour. Information about the presence of a previously
acknowledged infection is requested.
[0077] By inputting "Yes", the checks, see FIG. 6, FIG. 7, will be
repeated. If "No" is selected, the decision support module 17 will
continue--comparing heart rate, temperature and respiration rate
values against the SSC criteria.
[0078] It is possible to review the process supported by the sepsis
decision module by selection of button "Protocol Log" 129, which
causes a display of the captured information to be triggered. It is
possible to print out this documentation, see FIG. 14.
[0079] The sepsis treatment module 19 to support the clinician
during the treatment process can be started by an authorized person
only.
[0080] Sepsis Treatment Module
[0081] The clinician is supported to carry out the treatment of the
patient in the recommended way proposed by SSC by using the sepsis
treatment module 19. The treatment recommendations from SSC
referred to as Sepsis Resuscitation Bundle (SRB) is presented in
the display of the bedside patient monitor triggered by the sepsis
treatment module 19, see FIG. 10. Further, the sepsis treatment
module 19 monitors the implementation of the recommendations.
[0082] The sepsis treatment module 19 activates an indicator to
show that the sepsis treatment module is activated. In this example
the indicator is a yellow alarm displayed by the display of the
bedside patient monitor.
[0083] The lower area of the display of the bedside patient monitor
contains: [0084] a reminder list of the treatment recommendations
[0085] a timer showing the time already passed in this phase [0086]
three horizon trends for MAP, CVP and ScvO2 or SvO2, if these
measured values are available.
[0087] If ScvO2 or SvO2 are not being continuously delivered
through the second interface 107, a pop-up window will appear at
hourly intervals to ask for a manually measured value triggered by
the sepsis treatment module 19. When the window is closed without
the requested information having been filled in, a pop-up window
will appear after a predetermined time slice. The predetermined
time slice is especially 10 or 15 minutes after the first pop up
window appeared to request the required information.
[0088] The treatment process 6 according to the SRB supported by
the sepsis treatment module 19 is monitored by the clinician
support system. The status of all or one of the supported processes
will be displayed on the display of the bedside patient monitor, if
requested, using protocol log key 129. A standard clinician support
window can be selected, so that the status of the running treatment
module is displayed on the screen or display of the bedside patient
monitor. If the clinician support window is not displayed, the
display can be activated by user input. The clinician support
system window 131 is displayed in the lower area of the patient
monitor display. If the clinician support system window 131 is not
displayed, the status of the running treatment modules, here at
least status information about the running sepsis treatment
process, appears on the display of the bedside patient monitor
automatically once an hour, triggered by the sepsis treatment
module 19.
[0089] In FIG. 11 the window for displaying the status of the
treatment process of sepsis supported by the sepsis treatment
module is shown. This window is displayed on the screen of the
bedside patient monitor. The window content is in conformity with
the treatment guidelines proposed by the SSC.
[0090] By selection of "Enter Lact" key or button 121, the process
of manual information input of the lactate value is supported and
the information will be stored by the clinician support system.
When the lactate value is entered, or if a lactate value has
previously been entered or delivered by the information deliver
tool 27, the box will be checked.
[0091] Further, the clinician is supported by the registration of
blood cultures that were taken. The information of these blood
cultures can be delivered to the sepsis treatment module by manual
input. The information expected from the registered blood cultures
can be requested automatically after a predetermined time slice by
the information delivery tool. By checking the "Administer
Intravenous Antibiotics" box the clinician is supported in noting
the starting time of broad spectrum antibiotic therapy in a
convenient way.
[0092] The remaining three recommendations of the SSC treatment
guideline will be automatically compared to the available
information by the sepsis treatment module 19. Therefore, the
signals available through the second interface 107 will be checked.
A box will be checked when the sepsis treatment module has
recognized that the recommendation has been fulfilled.
[0093] If the ScvO2 value is manually measured, the value can be
entered in a convenient way by using the "Enter ScvO2" key 123. The
box will be checked automatically on whether the value fulfils the
recommendation.
[0094] In the case that MAP ScO2/SvO2 values are not automatically
delivered to the sepsis treatment module 19 by the second interface
for continuous measurement and neither by the information delivery
tool 27, the sepsis treatment module 19 provides the possibility
for manual input, which is possible, at the earliest, when the
timer indicates that 4 hours have lapsed since the activation of
the sepsis treatment module 19 to ensure that these values are
maintained halfway through treatment. The boxes are checked on
whether if the recommendation has been fulfilled.
[0095] More details of the recommendations are displayed on the
screen of the bedside monitor by choosing "show details" key 127.
This information is stored in the clinician support system storage
31 supporting sepsis. The bedside patient monitor comprises a
confirm button. The sepsis treatment module 19 recognizes the
activation of the confirm button by an authorized person. Thus it
is stored that the check boxes reflect the current treatment
status.
[0096] During the sepsis treatment phase an overview window
displaying the sepsis treatment status and enabling entries to be
made can be opened, see FIG. 11. The recommendations will be shown
as follows: [0097] Recommendations, which are not yet fulfilled,
are shown in black. They also appear in the list in the lower area
of the clinician support system screen. [0098] Recommendations of
the SSC guidelines which are overdue, are shown in red. [0099] In
the lower area of the clinician support system screen, all
recommendations are displayed. The recommendations that have been
carried out are shown in gray.
[0100] Ending Sepsis Treatment Module
[0101] When all recommendations have been fulfilled and confirmed,
or when 6 hours have passed since the treatment module was started,
the sepsis treatment module 19 is deactivated. A window is
generated by the clinician support system 1 to trigger the
clinician to generate a confirmation signal to start the sepsis
observation module 21. By pressing the "NO" key a signal is
generated to trigger an extension in the active state by 1 hour of
the sepsis treatment module 19.
[0102] Sepsis Observation Module
[0103] After deactivation of the sepsis treatment module the
clinician is supported in the observation of the patient's status
by the sepsis observation module. The SSC has generated a guideline
to observe the status of the patient after finishing the sepsis
treatment of the patient. The guideline is named Sepsis Management
Bundle (SMB). The parameters of the observation guideline supported
by the sepsis observation module 21 are presented and the
implementation of the recommendations is monitored. When the sepsis
observation phase begins, the clinician support system screen 131
will automatically appear on the monitor (if configured and
available on the monitor). In the lower area of the display, the
list of recommendations for the observation phase will replace the
list for the treatment phase. The timer shows the combined time for
the treatment and the observation phases.
[0104] Monitoring the Sepsis Management Bundle Recommendations
[0105] By the selection of the lower area of the clinician support
system screen, a signal is generated to trigger the appearance of
the sepsis observation window, see FIG. 13. In the case that the
observation is not triggered by manual input, the sepsis
observation window will appear automatically once every six hours,
triggered by the sepsis observation module 21, see FIG. 13.
[0106] This window supports the clinician to check the "Low Dose
Steroids" recommendation and/or the "Drotrecognin Alfa"
recommendation. These parameters may not be requested if the sepsis
observation module 21 or observation support module has been
configured not to do so in the actual hospital. The clinician is
requested to check the "Low Dose Steroids per policy" box at the
time of starting steroid therapy.
[0107] The clinician is requested to check the "Drotrecogin Alfa
per policy" box at the time of starting recombinant human activated
protein C therapy.
[0108] The clinician is requested by the window shown in FIG. 13 to
check the boxes "Glucose" and "Inspiratory Plateau Pressure" when
the timer has reached 20 hours to ensure that long-term
stabilization of these values is achieved. These boxes should be
checked if the recommendations are fulfilled.
[0109] By pressing the details button 127 on the screen, a window
containing more details about the recommendations will be opened.
The recommendations are stored in the sepsis observation module 21.
Therefore, the clinician support system comprises a storage 31,
which is part of the bedside patient monitor.
[0110] The stored recommendations can be updated from time to time
via the internet or the planned maintenance service.
[0111] By pressing the confirm button 125 on the sepsis observation
screen, a signal is generated assigned to the actual treatment
status reflected by the checked boxes.
[0112] Ending Sepsis Observation Phase
[0113] The sepsis observation phase support provided by the sepsis
observation module 21 normally ends 24 hours after the sepsis
treatment module 19 is started, as documented by the clinician
support system timer on the clinician support system screen.
[0114] The clinician will be asked to confirm with the "Yes" key
that normal monitoring should now begin. By selecting "No", the
sepsis observation phase supported by the sepsis observation module
21 is extended by a further 6 hours.
[0115] After completion of active observation, and a sepsis standby
phase supported by the sepsis observation module begins. The sepsis
standby phase allows time for further patient stabilization and
recovery. During this phase, the sepsis decision module 17 is
suspended. The standby phase is by default 7 days but can be
adjusted in the configuration mode of the sepsis observation module
21.
[0116] In the storage 31 all user interactions, alarms and phase
transitions of one disease-specified support are stored. So all
user interactions and alarms and phase transitions during the
sepsis treatment supported by the sepsis decision, sepsis treatment
and sepsis observation module are stored. The user can request to
display this stored information on the display of the bedside
patient monitor by pressing the protocol log key 129, and by
pressing a print button, this information is printed on a connected
printer. The displayed overview can be restricted, or not, to one
disease. So disease-specific overview sheets can be generated by
the clinician support system 1. A sepsis related overview generated
by the clinician support system 1 is shown in FIG. 14. This storage
contents is cleared whenever the patient assigned to the bedside
monitor is discharged.
[0117] It is essential that patients are discharged when monitoring
ends. As a reminder, the clinician support system 1 generates a
pop-up window when the monitor has been switched off or is in
standby mode, or is not monitoring basic vitals for a predetermined
time, especially more than 6, or 12 hours. This window supports the
clinician to discharge a patient by asking whether a new patient is
being monitored, and offers a pop-up key to discharge the previous
patient if this is the case.
[0118] The process of the sepsis decision, sepsis treatment and
sepsis observation procedure described before is stored in a
history file, which could be displayed and printed. The history
file could be used to figure out which person has made for an
example a manual entry or checked off recommendations, see FIG.
14.
REFERENCE NUMERALS
[0119] 1. clinician support system [0120] 3. decision support
module [0121] 4. decision process [0122] 5. treatment support
module [0123] 6. treatment process [0124] 7. observation support
module [0125] 8. observation process [0126] 11. disease-specified
decision module [0127] 13. disease-specified treatment module
[0128] 15. disease-specified observation module [0129] 17. sepsis
decision module [0130] 19. sepsis treatment module [0131] 21.
sepsis observation module [0132] 23. weaning treatment module
[0133] 25. weaning observation module [0134] 27. information
delivery tool [0135] 29. network connection [0136] 31. local
storage [0137] 101. bedside patient monitor [0138] 103.
display/screen [0139] 105. first interface--for manual
patient-related input [0140] 107. second interface--automated
sensor signal input [0141] 109. sensor [0142] 115. network
connection [0143] 119. central station [0144] 121. Lact key [0145]
123. ScvO2 key [0146] 125. confirm key [0147] 127. details key
[0148] 131. clinician support window
* * * * *